* 1. Did you participate in the live webinar on Wednesday, March 19th, 2014?
Please list your name how it should appear on your Certificate of Completion
* 2. Name
* 3. Profession
  4. If Other, Please Specify:
* 5. Organization
* 6. Email Address
* 7. Mailing Address
* 8. City
* 9. State
* 10. Zip Code
* 11. What kind of certificate do you need?

OBJECTIVES: Participants will be able to:

  1. Identify the structures that shape clinical interactions
  2. Discuss the means of developing an extra-clinical language of structure
  3. Rearticulate “cultural” formulations in structural terms
  4. Explain the process of observing and imagining structural interventions; and
  5. Describe the concept of structural humility
* 12. Did the webinar achieve its stated objectives?
Please rate the following where 1 is Poor and 10 is Excellent
* 13. The scholarship and expertise of Deliana Garcia, MA, International Research and Development, MCN
* 14. Your overall satisfaction with the webinar
* 15. The webinar presented new areas of knowledge and/ or new ideas/ methods to implement
* 16. The webinar contained information at a level commensurate with my training and experience
  17. If applicable, How helpful was the information you learned today in enhancing the performance and operations of your health center?
* 18. Was the content balanced and free of commercial bias?
* 19. Did the speaker/s fully disclose any conflict of interest and discussion of off-label usage of medication and/ or medical devices?
* 20. Please list at least one thing that you learned you think you will implement in your day-to-day work:
* 21. What additional training or Technical Assistance do you need?
* 22. Please describe any emerging primary care issues affecting your site?
  23. Additional Comments
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